Understanding BFRBs: What Are They and Why Do They Happen?

Have you ever found yourself repeatedly picking at your skin, pulling out your hair, or biting your nails without even realizing it? These behaviors may be more than just habits—they could be Body-Focused Repetitive Behaviors (BFRBs), a group of mental health conditions that impact millions of people.

Today, we’ll talk to you about what BFRBs are, the common types of BFRBs, the less-common types of BFRBs, and how to manage them. Hopefully, armed with this information, you’ll know what to look for when seeking BFRB Therapy in Woodland Hills.

A young woman is sitting on her couch in the living room reading a book, as she bites the skin on her thumb.

What Are BFRBs?

BFRBs are compulsive behaviors that involve repetitive self-grooming, such as hair-pulling, skin-picking, or nail-biting. While they may start as a way to relieve stress, over time, they can become difficult to control and may lead to physical harm.

Common Types of BFRBs:

Trichotillomania (Hair-Pulling Disorder): The urge to pull out hair from the scalp, eyebrows, eyelashes, or other body parts.
Excoriation Disorder (Skin-Picking Disorder): Repeatedly picking at the skin, leading to sores, scars, or infections.
Onychophagia (Chronic Nail-Biting): Persistent nail biting that can cause damage to the nails and surrounding skin. (Nail-biting can also cause damage to your teeth, which might not be as noticeable for you, but could show up in time at your dental check-ups.)
Dermatophagia (Skin-Biting Disorder): The compulsion to bite or chew on the skin, usually around the fingers.
Lip or Cheek Biting: Repeated biting of the inside of the mouth, leading to sores and irritation.

If you have struggled with any of these body-focused repetitive behaviors, you may have felt alone in your struggles and symptoms. Perhaps you didn’t know that there are tools available to help you manage BFRBs. I am going to share with you some of the strategies I share with my clients in our Woodland Hills BFRB therapy sessions. You are not the only person dealing with these behaviors, and there are ways to change your patterns and habits so that you can feel better.

Are BFRBs the Same as OCD?

A young girl is sitting on her couch in the living room, with her hands holding her head.

Body-focused repetitive behaviors and Obsessive Compulsive Disorder are related; they both involve unwanted compulsive behaviors. But the key difference is that OCD features an obsessive thought that the compulsive behavior is responding to. With BFRBs, the behavior is, in many ways, the obsession, whether a conscious or unconscious physical impulse. OCD is often treated with ERP (Exposure and Response Prevention), while BFRBs are treated with ComB (comprehensive behavioral) therapy. It is possible to have both disorders at the same time, and there are overlapping symptoms, making clarity about what you are dealing with crucial.

How to Manage BFRBs

While BFRBs can be challenging to overcome, there are effective strategies to help manage them. Like all behavioral changes, they can take time and practice to implement, and it is a gradual process. When utilized consistently, they can contribute to an improvement in symptoms and an overall decrease in stress, anxiety, and BFRBs.

1 – Increase Awareness with a Habit Tracker:

Developing an awareness of when, where, and why you engage in BFRB behaviors is one of the first steps you take when you attend in-person or online BFRB therapy. Some behaviors are a response to a build-up of stress and anxiety and are done very purposefully. Others can occur when idle and distracted, such as biting nails while watching TV.

Keeping track of when and where BFRBs happen can help you identify patterns and triggers. Do you feel the need to pull your hair around certain people, during certain events, at certain times of day? Are there times of year or seasons of your life when you are more compelled to partake in this behavior? Can you identify what any of these events have in common?
Apps like “TrichStop” or a simple journal can be useful for monitoring urges and progress. It can be tempting to assume you’ll remember what happened to trigger you, but that isn’t always a reasonable expectation to have of yourself. A journal or app that tracks progress can also be encouraging, as you see how you are adapting in order to manage your disorder better. For some who are visual learners, being able to look at a physical representation of what is going on can also help with clarity and pattern recognition.
Try to take note without judgement. You may experience feelings about when, where, and how your BFRBs show up. It is more beneficial and habit-sustaining to be able to observe your behavior without attaching your self-worth to it; be kind to yourself.

2 – Create a Competing Response:

A woman is sitting at a desk in front of her laptop, playing with a silver fidget spinner.

It can be difficult to avoid BFRBs when your hands aren’t occupied. Having go-to tools to utilize when you experience an OCD trigger for your body-focused repetitive behavior takes the guesswork out of managing your actions and helps you to build healthier habits.

Engage in an activity that keeps your hands busy when the urge strikes:

Try squeezing a stress ball instead of skin picking, hair pulling, or other BFRBs. Having a physical outlet for your anxiety that also prevents your hands from pulling, picking, or ending up in your mouth can be a two-in-one tactic.
Wearing textured gloves can not only block you from being able to bite your nails or pick your skin, for example, but the texture itself can help you to sense what you are doing. Reaching out to touch your skin with textured gloves on will feel very different than if you had bare hands.
Using fidget toys can keep your hands occupied when there is an urge to use them in a body-focused repetitive behavior. Fidget toys are often associated with ADHD, but that is not their only purpose. A fidget toy can be picked up and used on purpose when you feel the urge to partake in a BFRB, or you can keep one on hand for times when you are watching TV, reading or studying, or even talking on the phone.

3 – Practice Mindfulness Techniques:

Mindfulness techniques help to bring our attention to the present moment and make us conscious of what we are doing. Sometimes, BFRBs are done on purpose, and other times they are unintentional. Either way, being aware of what is happening will help you combat any harmful instincts.

Since BFRBs are often stress-related, calming techniques can help. A regular meditation practice can help to lower your base level of anxiety; you may listen to a guided meditation while commuting to work, waking up, or winding down for the day. You may utilize grounding techniques such as sensory observation to bring yourself to a present moment when you experience ruminating or worrying thoughts.
Deep breathing, mindfulness exercises, or progressive muscle relaxation may reduce urges. Deep breathing and muscle relaxation are both felt in the body, as you connect with your breath or focus in on the muscle group you are contracting and relaxing. This can help you feel aware of your physical self as a whole and distract you from the area of the body your BFRB is fixated on. These are great practices to do on a regular basis, but can also help in a pinch when you feel anxiety rising, or when you experience a trigger.
Practicing mindfulness in a safe space, such as therapy, can help you to implement it into your life and evaluate its benefits. If you are receiving ComB therapy for trichotillomania, dermatillomania, or any other BFRB, you will likely find that mindfulness is a part of it. Share with your therapist what you notice about your practice and how it is impacting you.

Key Takeaways

A young African American woman is sitting in her living room the couch as she smiles.

BFRBs are compulsive behaviors like hair-pulling or skin-picking that can be difficult to control. They are not “bad habits” that you picked up along the way that can be managed with “a little willpower.”
Some BFRBs are more common, such as skin-picking or hair-pulling, and some are more rare, such as cheek-biting, nose-picking, or hair-eating. No matter how rare or common the issue is, the same approach can be taken to deal with it.
Awareness, alternative behaviors, and stress management are key strategies to reduce symptoms. Your understanding of your BFRB may change over time or go through periods of higher recurrence than others. Being able to take note of what is happening and adjust accordingly is a good system for consistent improvement.
Your BFRB may or may not coexist with OCD. There is help available for you via BFRB and OCD therapy and specialized tools you can use in your day-to-day life. Whichever disorder is most intrusive is usually the best place to start, but you can and should work on both.
Believe in yourself! All behavior changes take time, practice, and patience. Progress is never a straight line in any modification you try to make to your life and habits. While BFRBs can be tough to deal with, they are not impossible to manage if you are determined to do the work and to pick yourself up when you have a misstep.

BFRB Treatment in Woodland Hills

Bodily Focused Repetitive Behaviors (BFRBs), which fall under the umbrella of Obsessive-Compulsive and Related Disorders, are often among the most misunderstood and stigmatized mental health conditions. While society readily offers compassion and support for physical health challenges like cancer or a broken bone, there’s still a lack of understanding and empathy for struggles such as nail-biting, hair-pulling, or skin-picking.

At Embracing You Therapy, we are committed to changing that. Our therapist specializes in treating BFRBs and OCD-related disorders, offering evidence-based care tailored to your unique experience. With the right support and treatment, you can regain your confidence and take back control of your life. You deserve to pursue your dreams without BFRBs standing in the way.